Renal impairment in transcatheter aortic valve implantation: incidence, predictors, and prognostic significance

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BACKGROUND: Renal impairment is a recognized complication of transcatheter aortic valve implantation (TAVI), impacting morbidity and mortality. Understanding its incidence, predictors, and prognostic implications is essential to optimizing patient outcomes. PURPOSE: To determine the incidence, predictors, and prognostic significance of renal impairment in patients undergoing TAVI. METHODS: This prospective observational study was conducted on 147 patients, with 144 completing the study. Patients with severe symptomatic aortic stenosis (aortic valve area (AVA) < 1 cm²) were included. Clinical, echocardiographic, and procedural parameters were analyzed to identify predictors of post-TAVI renal impairment, defined per Valve Academic Research Consortium (VARC)-2 AKIN criteria. RESULTS: Renal impairment occurred in 13.9% of patients post-TAVI. Compared to those without impairment, affected patients more frequently underwent ad-hoc revascularization (90% vs. 21.3%, P < 0.001), received higher contrast volume (median 200 mL vs. 130 mL, P < 0.001), and had longer procedures (82.5 ± 29 vs. 60.9 ± 28.3 min, P = 0.002). They also exhibited lower post-procedural ejection fraction (EF) (47.4% ± 9.7% vs. 59.8% ± 9.7%, P < 0.001) and higher incidence of regional wall motion abnormalities (60% vs. 12.3%, P < 0.001). Multivariate analysis identified ad-hoc revascularization (OR = 448.7, 95% CI: 17.09-11778.5, P < 0.001), lower EF (OR = 0.87, 95% CI: 0.79-0.97, P = 0.009), and contrast volume (OR = 0.98, 95% CI: 0.96-1.00, P = 0.045) as independent predictors. CONCLUSIONS: Renal impairment post-TAVI is multifactorial, with contrast volume, ad hoc revascularization, and reduced EF as key independent predictors. Minimizing contrast use and optimizing procedural strategies may mitigate renal risk and improve patient outcomes.

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